Provider Demographics
NPI:1508095373
Name:DULLENTY CHIROPRACTIC FAMILY WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:DULLENTY CHIROPRACTIC FAMILY WELLNESS CENTER, LLC
Other - Org Name:ADKINS CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:REBEKAH
Authorized Official - Last Name:WILKERSON-DULLENTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-785-2225
Mailing Address - Street 1:805 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4956
Mailing Address - Country:US
Mailing Address - Phone:573-785-2225
Mailing Address - Fax:573-355-5401
Practice Address - Street 1:805 W PINE ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4956
Practice Address - Country:US
Practice Address - Phone:573-785-2225
Practice Address - Fax:573-355-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952588956OtherPERSONAL NPI
MA1899002Medicare UPIN